Wolff-Parkinson-White syndrome (WPWS) is a congenital heart disease (PRKAG2. Genetic map 7q36) characterised by a premature ventricular depolarisation caused by an abnormal atrioventricular accessory pathway known as Kent’s bundle.
Prolonged QT syndrome (PQTS) consists of an abnormal prolongation of the QT interval on the ECG, which can be both inherited and acquired. This anomaly is known to favour the occurrence of malign cardiac arrhythmias, above all polymorphic ventricular tachycardia, ventricular fibrillation and “torsade de pointes”.
When taken separately, both syndromes have little incidence, which leads us to expect this incidence to be even lower when they are found on the same electrocardiogram. Incidentally, the current medical literature contains no publications on this topic. This clinical case aims to establish the existence of an electrocardiographic pattern characterised by WPW and a PQTS pattern on an ECG record. With a high susceptibility to crisis of tachycardia, especially at night, several episodes of syncope, even cardiac arrest.
The patient is a 24-year-old man. Since childhood, he has suffered from more than four tachycardia attacks, three documented syncope episodes, as well as two cardiac arrests recovered, for which he was treated with electric discharges.

When taken separately, both syndromes have little incidence,
which leads us to expect this incidence to be even lower when they
are found on the same electrocardiogram. Incidentally, the current
medical literature contains no publications on this topic. This clinical
case aims to establish the existence of an electrocardiographic pattern
characterised by WPW and a PQTS pattern on an ECG record. With a
high susceptibility to crisis of tachycardia, especially at night, several
episodes of syncope, even cardiac arrest.

The patient is a 24-year-old man. Since childhood, he has suffered
from more than four tachycardia attacks, three documented syncope
episodes, as well as two cardiac arrests recovered, for which he was
treated with electric discharges. Afterwards, he was treated with
radiofrequency ablation of Kent’s bundle, with permanent positive
results so far (Figure 1).

Some Thoughts on this Case Report

Currently, our research team is working on features and
management of this peculiar entity cardiology. Unfortunately, some are
unknown to us yet.

The patient was positive for the gene of LQT1 (KCNQ1) (Figure 2).

He had not taken any medication to induce QT interval
prolongation.

The fundamental symptoms were strong palpitations (especially at
night), crises of severe tachycardia (greater than 250 bpm), episodes
of syncope documented, with total reduction of consciousness,
hypovolemic shock, reaching suffering two cardiac arrests.

The patient specific medication was never against the long QT, since
he was never diagnosed with it: The long QT went unnoticed by your
physicians. Our research team was who discovered to the two entities
together in the same record ECG.

Although is a WPW intermittent, in all leads there is always a
prolonged QT interval (values greater than 0.480 seconds), as can be
measured in the ECG recording.

Following ablation, the patient has not suffered similar symptoms
so far. Possibly this is because the patient is with sodium blockers as
treatment, currently:

Your physicians chose the drug “hydroquinidine hydrochloride”
against the WPW (a sodium blocker channels, class I) by orally. Because
it has a stabilizing effect on the myocyte membrane and the capsule form with allows a stable absorption hydroquinidine for 8-12 hours and
avoids the “peaks “in the hematic concentration of the substance. The
maximum dose is 12.9mg/kg/ day, orally in two intakes each 12 hours.
The dose is interrupted or reduced when the arrhythmia is eliminated
or improved, or if hypotension occurs, the QRS complex widens by 50%
or more, or the maximum dose is achieved.

The risks of intoxication or adverse effects are also lower.

Since the patient remains without symptoms following the radiofrequency
ablation, we decided to maintain the current treatment but
with strict control of the patient.

QT interval duration following the ablation was similar to the
duration before ablation. Ie, a prolonged QT.